The textual organization of placement into long-term care: issues for older adults with mental illness

Arranging placement of older adults from hospital mental health units into nursing homes or assisted living facilities can be difficult and protracted. The difficulty in placing these individuals is often attributed to stigma; that is, personnel in nursing homes are reluctant to accept mentally ill older adults because of the fear of mental illness and violence. Using an institutional ethnographic approach, we argue the importance of exploring how nursing home access is organized, especially the institutional process of placement. Our study, examining the process of placing older adults from mental health units into nursing homes or assisted living facilities within a western Canadian city, reveals how three specific textual points within the institutional process of placement do not work well for older adults with mental illness. These textual points include: constructing the older adult as a 'placeable' person, the first-level match and the second-level match. After exploring why the three specific points in the process do not work well for mentally ill individuals, we reconsider the explanation of stigma, and then suggest implications for change.